Head of the
commission for bioethics of the diocese of Fréjus-Toulon, Pierre-Olivier
Arduin analyses the status conferred to artificial feeding by the end of
life law currently in force. This “detail” could turn against
Leonetti Law and threaten the precarious balance.
Treatment or care?
The law of 22nd April 2005 grants the patient, whether she/he is nearing the
end of life or not, the freedom to refuse “any treatment”, the text
expressly including in this provision the withdrawal of artificial feeding.
What contest various bioethicians, the assisted feeding does not seek to
thwart an organic pathology affecting this function but to alleviate a
simply mechanical problem by responding to a basic need
of the organism. Moreover, they suggest replacing the expression "assisted
feeding" by "medical nutrition" in order to well insist on its
ordinary character for the preservation of life.
Therefore, in no case, here we can talk about unreasonable obstinacy or
about disproportionate treatment "because precisely the medical feeding
can be continued during a long time, without major side effects and with
great efficacy to support patient’s life, what is exactly the definition of
a proportionate care". To let die of inanition a patient who cannot feed
himself by withdrawing nutriment administration, is a euthanasia act,
insofar as the death is wanted for itself as we can prevent it, without
being a matter of therapeutic obstinacy. Director of the ethical centre of
Cochin hospital, Véronique Fournier recognises that "feeding and
hydration withdrawal can be decided with the intention to let die"1.
"Rather than talking about disproportionate care, may we admit that it is
the patient’s life which seems “disproportionate" due to its weak "quality"
?", wonders Pierre-Olivier Arduin.
Pro-euthanasia strategy
This "burning" question about artificial feeding withdrawal is, since
a long time, one of the levers of pro-euthanasia militants. Thus, in
September 1984, during the 5th Global Conference of the associations “for
the right to die with dignity”, Helga Kube, Australian, yet indicated the
way to obtain the decriminalisation of euthanasia : "if we can obtain
from people that they accept treatment and care withdrawal, particularly the
interruption of any feeding, they will see what painful way is to die and
then will accept, for patient welfare, the lethal injection".
"The Pierra’s affair"
It is exactly this method which has been used to shake public opinion with
Hervé Pierra’s euthanasia.
Young men with psychological fragility, Hervé Pierra regularly smoked
cannabis, and then schizophrenia appeared, which obliged him to take
medicines generating impotence. One day, his father who was fire chief,
found him hanged and achieved to save him. But the lack of oxygenation of
his brain left Hervé in a persistent vegetative state. "Of course we
thought about ending his life, but we knew that we could have not survived
to this act", his mother told. But, at the same time, France debated the
"right to die", after Marie Humbert "euthanized" her son Vincent, on 30th
September 2003. Then Paul and Danièle Pierra followed "to the smallest
detail" the "Humbert’s affair" as well as the works of the
parliamentarian Commission on the end of life. At the same time they joined
the Association for “the right to die with dignity” (ADMD) and the
association “Faut qu’on s’active”, founded by Marie Humbert. "We were
very hopeful for Hervé’s liberation", Mr. Pierra said.
Jus after the promulgation of Leonetti law on 22nd April 2005, Pierra
spouses asked the withdrawal of the feeding tube from their son, from now on
accepted as a treatment that it is possible to stop. First the medical team
refused, reminding that "the assisted feeding is a comfort care and not a
treatment” and that “removing it will be equal to euthanasia”.
After 14 months of confrontation, finally Dr Régis Aubry, chairman of the
national committee for palliative care development, accepting the parents
demand, enabled Hervé’s life support equipment to be disconnected. Like
Terry Schiavo who died on 31st March 2005 in USA (see Gènéthique n°64),
Hervé Pierra starved for 6 days before dying in dreadful convulsions.
"We called it a scandal of a dirty death that Leonetti law authorises",
we accuse of hypocrisy a law which refuses the lethal injection, we
implicate the medical team in charge of Hervé Pierra… but, here, it is the
new status of artificial feeding which is the intimate drive of this human
drama.
Today, in France, the strategy of pro-euthanasia militants aims at
denouncing the ambiguity of the current law, calling for "the fatal
choice of legal euthanasia supposed to remedy". For Pierre-Olivier
Arduin, "the legislator falls into trap of approximations which make the
game of their rivals", here the supporters of euthanasia
decriminalisation… 
1.
Le Monde, 19/03/08
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On last 9th April, the popular jury of
the criminal court of Val d’Oise discharged Lydie Debaine, prosecuted for
having killed his mentally and motor disabled daughter. On 14th May 2005,
Mrs. Debaine administered to her 26-year-old daughter several tranquilizers
before drowning in a bath.
Denial of life and euthanasia
This decision gave rise to various and lively reactions. Among them, let’s
cite the one from Dominique Quinio who wonders about the sense of this
discharge: "Would killing a person severely physically and mentally
injured not be a crime? Would this person be less human than other victims?".
For Denis Sala, researcher at the Ecole nationale de la Magistrature (French
National School for the Training of Judges and Prosecutors, this affaire
reveals "a decriminalisation of what it is called compassionate homicides".
Patrick Baudry, sociologist and professor at the University of Bordeaux III,
also regrets a judgment which tends towards “a trivialisation of
euthanasia act".
At a time when pro-euthanasia claims are in the media limelight, this case
seems to be a new resonance box. How, above all within the current context,
do not be worried about applauses which first acclaim this discharge? "Does
not such an approval reveal a vague hostility for ill or disabled people?",
wonders Danielle Moyse, doctor in philosophy and associate researcher at
CNRS-EHESS. “In fact, one thing would be to take note of difficulties
that can lead a mother to a desperate act and to conclude to an urgent need
of a solidarity duty in a position to prevent it, another to double the
legal absolution of a murder by an enthusiasm susceptible to encourage any
act of same nature.”
Killing may not be the solution
It is in this direction the Collective against handiphobia reacted, through
Damien and Sophie Lutz, Philippine’s parents, an 8-year-old, microcephalic
and multiply disabled girl. The Collective regrets that "the discharge of
Mrs. Debaine pushes people in their shadows" because "various parents
fear to crack up" and "resist to the hopelessness by carrying on
thinking day after day that their child has her/his place among the living".
Parents of disabled children, even if they understand that Mrs. Debaine
could get out of her depth, say how they need "a strong message from the
society which remind us that any life, even weaken, is precious", "to
be sure that this act is not a solution, shall not be a solution".
The attorney general of the Court of Appeal of Versailles, Jean-Amédée
Lathoud, appealed the criminal court of Val-d’Oise decision because "this
discharge could (…) be understood as an encouragement to the
voluntary attack on the life of disabled people, who deserve our protection
and our support". For him, the department of the Public prosecutor has
the duty to apply the law and to condemn the accused, even to a nominal
sentence and this, in the general interest and for the sake of ethical
values and founding principles of our society.
If, after this affair, the deputy Jean Leonetti, in charge of assessing the
law on the end of life, recognised that "legally and judicially speaking,
we can hardly imagine making a law allowing to eliminate the disabled people",
he said he worked "on a streamlining of the judicial procedure for
compassionate death"… |
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Created at the initiative of Jérôme Lejeune Foundation and of the centre of
research on cord blood of the University of Newcastle, the international
consortium Novussanguis was officially launched on last 14th May, at
the School of Medicine, in the presence of 200 participants of
different nationalities. Among the presentations, we underline the ones of
Pr. Axel Kahn (president of the Paris-Descartes University) and of Mr.
Claude Birraux (deputy and chairman of the Parliamentary office for the
evaluation of scientific and technological choices).
A responsible research
Launched under the auspices of the president of the European parliament,
Hans-Gert Pöttering, and the sponsorship of the French ministry for research,
Novussanguis wants to develop and encourage a responsible research on
adult stem cells and cells derived from cord blood. Gathering about
fifteen laboratories, Novussanguis favoured three
orientations: research, innovation and training of the next generation of
researchers. Thus, does Novussanguis want to come up to patients’
expectations who could have a treatment thanks to adult stem or cord blood
cells, while making sure not to give rise to vain hopes?
…pertinent and necessary
Particularly promising for cell therapy and regenerative medicine by their
strong potential of differentiation and multiplication, today, adult stem
and cord blood cells can treat more than 80 pathologies: diseases
related to the blood system (leukaemia), to the bone marrow, to the immune
system (bubble child), to the nervous system, to the heart, to the
metabolism (juvenile diabetes)...
For Pr. Eliane Gluckman (Saint-Louis Hospital, a pioneer in cord blood
transplantation in Europe), Novussanguis is an "indispensable"
project: "it was time an initiative of this type was launched to
federate the research on this field".
The first projects financed for a total of 3 million euros will concern:
> Tissue engineering of nervous and pancreatic tissues, but also of bones,
cartilages, tendons and vessels;
> Regeneration of corneal tissue;
> Regeneration of tissues after myocardial infarction;
> Preservation of haematopoietic stem cells;
> Epigenetic profile of cord blood stem cells.
1. See
www.novussanguis.org
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